Conditions Affecting Eye Health and Their Treatments

During your eye exam, our dedicated staff will measure your visual acuity and performs a series of tests to determine the overall health of your eyes. You will likely be receiving eye drops to perform measurements of your eye pressure in each eye (a test for glaucoma), as well as eye drops to dilate your pupils so your doctor may perform a full evaluation of the retina and optic nerve located in the "back of the eye."

Our office does provide temporary sunglasses to assist you while your eyes remain dilated once you leave our office, as eyes that have been dilated are much more sensitive to sunlight and bright lights. Some people prefer not to drive after having their pupils dilated; these patients will often bring someone else to accompany them to the office to be able to drive them home after their eye examination.

Nearsightedness (myopia) is a condition in which far away objects appear blurred while near objects are usually seen clearly without correction. Because the effective refractive power of a myopic eye is too strong, the image of an object being viewed is focused in front of the retina rather than directly upon it.

Corrective eyeglasses or contact lenses compensate for this refractive error and help to focus the image on the retina. Nearsightedness can also be corrected by using laser refractive surgery, such as Lasik on the cornea, or by surgically implanting a corrective lens behind the iris, as is done during cataract surgery.

Farsightedness (hyperopia) is a condition in which far away objects can be seen more easily but there is difficulty in near vision. It is caused by a defect of refraction in which the image is focused behind the retina of the eye rather than directly upon it. Farsightedness can also be corrected with glasses, contact lenses and, in some cases, with laser vision correction surgery.

Astigmatism is caused by a non-uniform curvature of the refractive surfaces specifically the cornea and lens of the eye. (“Typically eyes with astigmatism are described as being more "oval" than "spherical or round.") As a result, light rays do not all come to a single focal point on the retina. Instead, some the image being viewed focuses on the retina while the remainder of the image being viewed focuses in front of or behind the retina.

The condition may be congenital, or it may result from disease or injury. It often occurs in addition to nearsightedness or farsightedness.

The spherical lenses used to correct nearsightedness and farsightedness must be specially adapted to correct the out of focus plane of vision of the astigmatic eye. A special cylindrical lens is placed in the out of focus axis to correct the condition. In most cases, glasses, contact lenses and even possibly laser vision correction surgery are the most effective means of correcting astigmatism.

Presbyopia is not a disease as such, but a condition that affects everyone at a certain age. The first symptoms are usually noticed between the ages of 40 50, though the ability of the eye to focus declines throughout life.

For those with good distance vision, it may begin with difficulty reading fine print, particularly if the lighting is poor. Some individuals notice eyestrain when reading for long periods. Many people with presbyopia complain that their arms have become "too short" in order to hold reading material at a comfortable distance.

The natural weakening of the human lens' ability to focus at near causes it to no longer be able to focus light from near, close range objects onto the retina. Presbyopia is easily fixable with reading glasses, bifocals, multifocal or monovision contact lenses and sometimes surgery.

A cataract is clouding or opacity of the natural lens, the part of the eye responsible for focusing light and producing clear, sharp images. Over time, the lens clouds, making images look blurred or fuzzy.

The most common form of cataract is age related, usually starting after age 50, but sometimes they can begin at a younger age. Even though a cataract can start to form in your 50s, vision problems may not occur until much later.

Other factors that may contribute to a cataract include sunlight exposure, smoking, poor nutrition, eye trauma, systemic diseases such as diabetes, and certain medications such as steroids.

Symptoms: Just as a smudged or dirty camera lens may spoil a photograph, opacity in the natural lens of the eye can result in a blurred image. Patients with cataracts usually complain of blurred vision either at distance, near, or both. This may interfere with tasks such as driving or reading.

Other common complaints include glare, halos, and dimness of color vision.

Diagnosis: Cataracts are usually diagnosed by your eye doctor. Your level of vision, or visual acuity, is a helpful factor in determining the degree of cataracts.

Dilated eye exam: Drops are placed in your eyes to widen, or dilate, the pupils. Your eye doctor uses special instrumentation to look into your eyes to diagnose the severity of cataract.

What to expect: The progression of cataracts is highly variable; however, they will invariably worsen in severity over time. Changing glasses may sometimes be useful in improving vision as the cataract progresses, since cataracts may induce relative nearsightedness. For most patients, however, changing glasses has minimal impact on overall visual quality. Besides changing glasses, the only other option for treatment of cataracts is cataract surgery.

Treatment: The decision for cataract surgery is based on the degree to which the patient's vision is impaired, and the impact that impairment has on his or her quality of life. When a patient is significantly bothered by symptoms of cataract, such as when vision loss interferes with your everyday activities, such as driving, reading, or watching TV, cataract surgery is usually offered.

Even with moderately good visual acuity, cataract surgery may benefit the patient by reducing other symptoms such as glare or dimness of vision. Symptoms of early cataracts may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually at least 2 3 weeks apart, or more.

Dry eyes

At least 60million Americans suffer from some degree of dry eye symptoms such as irritation, burning, intermittent blurring of vision, and even excessive tearing. Symptoms from dry eyes are often made worse on cold windy days in the winter. This occurs when there is decreased tear production from the tear gland and/or increased tear film evaporation.

Tearing in adults

Small glands (called lacrimal glands) located in the eye's orbit, the white part of the eye, and lining of the eyelids constantly produce tears to keep the eye moist, lubricated and healthy.

How do tears drain from the eye?

As new tears are produced, old tears drain from the eye through two small openings called the upper and lower puncta, which are located at the inside corner of the upper and lower eyelids near the nose. The tears then move through a passage called the canaliculus and into the lacrimal sac. From the sac, the tears then drop down the tear duct, called the nasolacrimal duct, and drain into the back of the nose and throat. That is why our noses run when we cry.

Excessive tearing may occur from the following:

• Injury
• Birth defects
• Infection or tumor of the lacrimal (tear) drainage system
• Eyelid or eyelash disorders
• Infection in the eye
• Wind, smoke, fumes or other environmental irritants
• Glaucoma
• Certain medications; allergic reaction
• Dry eyes
• Foreign material in the eye
• Scratch on the eye

How is the cause of excessive tearing determined?

A thorough eye examination by an ophthalmologist is necessary to determine the cause of excessive tearing.

He or she may also:

• Irrigate your tear drainage system with fluid to make sure the pathway is open
• Measure tear production
• Measure eye pressure
• Illuminate the tear drain with a fluorescent dye test
• Perform computerized tomography (CT) scanning

How is excessive tearing treated?

Once your ophthalmologist determines the cause, treatment may include one or more of the following:

• Surgical opening of blocked drainage system
• Surgery to repair an injured drainage system
• Removal of an injured eyelash or foreign body in the eye
• Adding a new opening from the lacrimal sac into the nose, a procedure known as dacryocystorhinostomy dcr); use of lubricating eye drops or ointment
• Insertion of an artificial tear duct implant

Glaucoma consists of a group of diseases of the optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. Although raised intraocular pressure (IOP) is a significant risk factor for developing glaucoma, there is no set threshold for intraocular pressure that causes glaucoma.

One person may develop nerve damage at a relatively low pressure, while another person may have high eye pressure measurements for years and yet never develop damage. Untreated glaucoma can lead to permanent damage of the optic nerve and resultant visual field loss, which can progress to blindness.

Treatment for glaucoma can include eye drop medications, laser treatments and, in some cases, even surgery. Glaucoma is the second leading cause of blindness. Glaucoma affects one in two hundred people aged fifty and younger and one in ten over the age of eighty.

Laser Iridotomy is a surgical procedure used to treat closed angle glaucoma. This laser procedure is also performed in patients who are at risk of closed angle glaucoma. As with many medical conditions & treatments, it is preferable to treat patients at risk and thereby avoid vision loss.

What is closed angle glaucoma?

Like other forms of glaucoma, closed angle glaucoma has to do with pressure inside the eye. A normal eye constantly produces a certain amount of clear liquid called aqueous humor, which circulates inside the front portion of the eye. An equal amount of this fluid flows out of the eye through a very tiny drainage system (called the drainage angle), thus maintaining a constant level of pressure within the eye.

There are two main types of glaucoma. The most common type is open angle glaucoma in which fluid drains too slowly from the eye and causes a chronic rise in eye pressure. In contrast, closed angle glaucoma causes a more sudden rise in eye pressure.

In closed angle glaucoma, the drainage angle may become partially or completely blocked when the iris (the colored part of the eye) drops over this area. The iris may push forward and completely block the aqueous fluid from leaving the eye, much like a stopper in a sink. In this situation, the pressure inside the eye can rise very quickly and cause an acute closed angle glaucoma attack.

Symptoms of an acute closed angle glaucoma attack include:

• Severe ocular pain and redness
• Decreased vision
• Colored halos
• Headache
• Nausea
• Vomiting

Because raised eye pressure can damage the optic nerve and lead to vision loss, a closed angle glaucoma attack must be treated immediately. Unfortunately, individuals at risk of developing closed angle glaucoma often have few or no symptoms prior to the attack.

Some early symptoms in patients at risk for closed angle glaucoma include blurred vision, halos in their vision, headache, mild pain or redness. Patients who are at risk of developing closed angle glaucoma should have a laser iridotomy.

Many common medications, including over the counter cold medications and sleeping pills (and any other medication that can dilate the pupil), should be avoided until after the laser procedure is completed.

What happens during laser iridotomy?

Using a laser, a small hole is made in the iris to create a new way for the aqueous fluid to drain from your eye. The new drainage hole restores the balance between fluid entering and leaving your eye, lowering eye pressure.

The surgery is performed by your ophthalmologist (eye M.D.) on an outpatient basis, usually in his or her office. Your eye will be numbed with eye drops. A contact lens is placed on your eye to serve as a precise guide for the laser and a hole about the size of a pinhead is made in your iris. Typically, it will be concealed from view by your upper eyelid.

The actual procedure will only take a few minutes. You should plan to have someone drive home afterwards.

Are there any risks involved?

Complications following laser iridotomy are uncommon. However, some patients may experience some side effects, including:

• Blurred vision
• Minor bleeding
• Need for retreatment or a different type of treatment
• Double vision (rarely)

The risks and side effects of glaucoma treatment are always balanced with the greater risk of leaving glaucoma untreated.

If you have diabetes mellitus, your body does not use and store sugar properly. High blood sugar levels can damage blood vessels in the retina, the nerve layer at the back of the eye that senses light and helps to send images to the brain. This damage to retinal blood vessels from chronic elevation of blood sugar levels is referred to as diabetic retinopathy.

Types of diabetic retinopathy

There are two types of diabetic retinopathy:

• Non proliferative diabetic retinopathy (NPDR)
• Proliferate diabetic retinopathy (PDR)

NPDR, commonly known as background retinopathy, is an early stage of diabetic retinopathy. In this stage, tiny blood vessels within the retina leak blood or fluid. The leaking fluid causes the retina to swell or to form deposits called exudates. Many people with diabetes have mild NPDR, which usually does not affect their vision. However, vision is affected when blood flow to the central portion of the retinal, called the macula, is significantly affected. The result is macular edema (i.e. leakage of fluid from blood vessels into the macula) and/or macular ischemia (i.e. lack of proper blood flow to the macula).

PDR is present when abnormal new vessels (neovascularization) begin growing on the surface of the retina or optic nerve. The main cause of PDR is widespread closure of retinal blood vessels, thereby preventing adequate blood flow. The retina responds by growing new blood vessels in an attempt to supply blood to the area where the original vessels closed. Unfortunately, the new, abnormal blood vessels do not re supply the retina with normal blood flow. The new vessels are often accompanied by scar tissue that may ultimately cause wrinkling or detachment of the retina.

Macular degeneration (age related macular degeneration or ARMD) is a medical condition predominantly found in elderly adults in which the center area of the retina, known as the macula, suffers thinning, atrophy, and in some cases bleeding. This can result in loss of central vision, which ultimately can cause the inability to see fine details, to read, or to recognize faces. According to the American Academy Of Ophthalmology, it is the leading cause of central vision loss (blindness) in the United States, today, for those over the age of fifty years. ARMD is usually characterized as either being dry (the milder form) or wet (the more severe form).

Pterygium (pronounced tur ij ee um) and pinguecula (pronounced pin gwek yoo la) are growths on the cornea (the clear front window of the eye) and the conjunctiva, which is the thin, filmy membrane that covers the white part of your eye (sclera). Both types of growths are believed to be caused by dry eye and environmental elements such as wind, dust and ultraviolet light (uv).

A pterygiulm is a growth of fleshy tissue on the conjunctiva that extends over the cornea (the clear front window of the eye). This growth may remain small or grow large enough to interfere with vision.

A pinguecula is a yellowish patch or bump on the conjunctiva, most often on the side closest to the nose. It is a change in the normal tissue that results in a deposit of protein, fat and/or calcium. It is similar to a callus on the skin.

Symptoms of both pterygium and pinguecula can range from mild to severe and may include:

• Redness and/or inflammation especially during the growth of a pterygium;
• Blurred vision;
• Irritation;
• Dryness;
• Itching;
• Burning;
• Gritty feeling;
• Feeling of having foreign material in your eye

How are pterygium and pinguecula treated?

 In many cases, no treatment is needed. When a pterygium or pinguecula becomes red and irritated, eye drops or ointments may be used to help reduce inflammation. If they grow large enough to threaten sight or cause persistent discomfort, they can be removed surgically. They are also sometimes removed for cosmetic reason.

Despite proper surgical removal, pterygium or pinguecula may return. Surface, radiation or medications are sometimes used to help prevent recurrences. However, the best way to avoid recurrences is to limit exposure to the environmental factors that contribute to their growth. This includes:

• Adequately protecting your eyes from excessive uv light with proper sunglasses
• Protecting your eyes in dry, dusty conditions & treatments with proper eyewear
• Applying artificial tears to your eyes in dry conditions & treatments

A migraine is a common neurological condition occurring in at least 15 20% of the population and in up to 50% of women. Classic migraine usually starts with visual symptoms (often zigzag lines, colored lights or flashes of light expanding to one side of your vision over 10 30 minutes), followed by a single sided pounding severe headache.

The headache is usually associated with nausea, vomiting, and light sensitivity. Sometimes visual symptoms and even neurologic dysfunction may occur without the headache. This is called "migraine variant".

Common migraine may cause only a headache felt on both sides of the head. This form of migraine may be responsible for the headaches that many people may have attributed to tension, stress, or sinus pain.

What causes migraine?

While it is not clear exactly how a migraine works, it is believed that the basic cause of migraine is an abnormality in the neurotransmitter serotonin, an important chemical used by your brain cells. During a migraine attack, changes in serotonin affect blood vessels in your brain, often causing the vessels to constrict. These changes in blood flow decrease the oxygen supply to the brain. If this oxygen supply is decreased long enough, a stroke is possible. Fortunately, this is rare.

Certain foods may trigger a migraine attack, including:

• Aged cheese, nitrates (often found in cured meats, hot dogs and other processed foods)
• Chocolate, red wine, monosodium glutamate (usually called msg, a flavor enhancer frequently found in some food)
• Caffeine, aspartame (the artificial sweetener found in nutrasweet
• Alcohol

Hormonal changes are frequently associated with migraine, especially pregnancy, use of birth control pills, and menstrual periods or menopause. Patients often attribute their migraine to stress.

While stress probably does not cause migraine, it may affect the frequency of attacks. Interestingly, however, most migraine attacks seem to occur following stress relief, often at the beginning of a weekend or vacation. People who experience migraine often have a family history of headaches or a prior history of motion sickness.

What are symptoms of migraine?

 The most common sign of migraine is headache lasting for hours or days. Symptoms generally include:

• Pounding pain on one side of your head (or steady pain on both sides of your head)
• Sensitivity to light and sound
• Nausea, vomiting

The visual symptoms (usually in both eyes but often to one side) have some of the following characteristics:

• A spot of blurring that expands to one side over 10 30 minutes
• An expanding border often described as zigzag lines, "shimmering" or resembling "heat waves" or "sparklers"
• Vision loss in one eye only, involving the entire field or only the upper or lower section

Rare symptoms include

• Double vision
• Change in lid position (lid droop)
• change in pupil size (both smaller and larger)

In very rare cases, the visual problems associated with migraine may not entirely resolve. This may be due to a stroke associated with migraine.

How is migraine treated?

Treatment usually first involves avoiding factors known to precipitate a migraine attack, such as foods, environmental triggers such as perfume, and medications such as birth control pills. Over the counter anti-inflammatory medications (such as aspirin, ibuprofen, etc.) may reduce the severity of an acute attack. Drugs that constrict the blood vessels, including caffeine and ergotamines are sometimes used. Also, certain prescription medications that deal directly with the presumed chemical imbalances of migraine are available (including imitrex, amerge, maxalt, and zomig).

If migraine attacks are severe or frequent enough, medication may be required on a regular basis (prophylactic medication groups are tricyclics, beta blockers, calcium channel blockers, and some anti-seizure medications).

Herpes zoster, commonly known as "shingles," is caused by the same virus responsible for chicken pox. After being infected with chicken pox as a child, the virus remains in your body in an inactive, or dormant, stage. Later in life, the virus can be reactivated if your body's immune system breaks down.

This may happen due to the normal aging process of a number of other factors, including:

• Illness, such as HIV (Human Immunodeficiency Virus)
• Fatigue
• Emotional or physical stress
• Poor nutrition
• Chemotherapy or radiation therapy
• Certain medications

What are the symptoms of herpes zoster?

The herpes zoster virus lives in your body's nerve tissues. When the virus is reactivated, the first symptoms are pain, itching and tingling of the skin, followed by redness, numbness and development of a rash. The rash develops into small, fluid filled blisters called vesicles, that later break open and form crusty scabs.

The outbreak of shingles typically lasts for a few weeks, but in severe cases the rash can leave permanent scars, pain, numbness or skin discoloration.

How does herpes zoster affect the eye?

The herpes zoster virus can cause numerous eye problems, including:

rash on the upper and lower eyelids

redness, burning and discharge of the conjunctiva ( the thin, filmy membrane that covers the inside of your eyelids and the white part of your eye), also known as conjunctivitis or "pink eye"

• Dry eyes
• Increases risk of bacterial infection of the eye
• Blurred vision and light sensitivity
• Inflammation, redness, swelling and pain inside the eye, also known as iritis
• Optic neuritis (inflammation of the optic nerve behind the eye)
• Breakdown of the surface of the cornea

More severe complications include:

• Glaucoma,
• Cataract formation
• Double vision
• Scarring of the eyelids and cornea (the clear front window of the eye)

How is the eye symptoms treated?

• Cool compresses
• Anti-inflammatory medication
• Antiviral medication
• Antibiotic eye drops
• Lubricating eye drops
• Pain medication

More serious complications from herpes zoster (corneal scarring, glaucoma, cataracts, double vision, and scarring of the eyelids) will require more extensive treatment by your ophthalmologist (eye m.d.). Surgery and long term care of these problems may be necessary.

Is herpes zoster contagious?

Herpes zoster is much less contagious than chicken pox, but it is important for someone with shingles to avoid these who may be more easily infected, such as infants, pregnant women, and people with a weakened immune system. It can only be passed to others who have not had chicken pox. The newly infected people will then develop chicken pox, not shingles.

Infections from herpes zoster are likely to recur from time to time, especially in people whose immune systems are weakened. Prompt treatment of the infection is important to reduce the risk of severe complications that may threaten sight.

Herpes simplex eye disease

Herpes simplex is a virus that infects the skin, mucous membranes and nerves. There are two major types of herpes simplex virus (HSV).

Type I is the most common and primarily infects the face, causing the familiar "cold sore" or "fever blister". Type II is the sexually transmitted form of herpes, infecting the genitals. While both can spread to the eye and cause infection, type I is by far the most frequent type associated with herpes simplex eye disease.

Type I herpes is very contagious and commonly transmitted by skin contact with someone who has the virus. Almost everyone, about 90% of the population, is exposed to Type I herpes, usually during childhood. After the original infection, the virus lies in a quiet or dormant period, living in nerve cells of the skin or eye. Occasionally, the virus can reactivate and cause new cold sores or blisters to form.

Reactivation can be triggered by any number of reasons, including:

• Stress
• Sun exposure
• Fever
• Trauma to the body (injury or surgery)
• Menstruation
• Certain medications

Infection can be transferred to the eye by touching an active lesion (a cold sore or blister) and then your eye.

What is herpes simplex eye disease?

Once present in the eye, herpes simplex typically infects the eyelids, conjunctiva (the thin, filmy mucous membrane that covers the inside of your eyelids and the white part of your eye), and cornea (the clear front window of the eye).

Signs and symptoms of the infection include:

• Red eye
• eye pain
• tearing
• light sensitivity
• irritation
• blurred vision

The disease usually begins with an infection on the surface of the cornea. Your eye will turn red and become sore and sensitive to light. After time, the infection may spread deeper into the cornea and cause inflammation inside the eye or possibly permanent scarring of the cornea. Chronic ulcers, which are sometimes very difficulties to heal, may also develop on the cornea.

How is herpes simplex eye disease treated?

The form of treatment will depend on the severity of the infection. Mild infection is typically treated with topical and sometimes oral antiviral medication. Your ophthalmologist may gently scrape the affected area of the cornea to remove the diseased cells. In cases of severe scarring and vision loss, a cornea transportation may be required.

It is very important to consult an ophthalmologist before beginning any treatment since some medications or eye drops may actually make the infection worse.

How can recurrent infections from herpes simplex be prevented?

There is no complete cure for herpes - once the virus is in the body, you cannot get rid of it. After an initial outbreak of ocular herpes, there is a 50% chance of having a recurrence of the infection. The second outbreak may come weeks or years after the initial attack.

The following preventive measures can help control recurrent outbreaks:

• If you have an active cold sore or blister, avoid touching your eyes
• Avoid over-the-counter steroid eye drops. Steroids cause the virus to multiply
• Stop wearing contact lenses if you keep having multiple recurrences
• See an ophthalmologist immediately if symptoms of ocular herpes begin to return

Conjunctivitis is the term used to describe inflammation of the conjunctiva – the thin, filmy membrane that covers the inside of your eyelids and the white part of your eye (sclera). Conjunctivitis is most commonly referred to as "pink eye”.

The conjunctiva, which contains tiny blood vessels, produces mucus to coat and lubricate the surface of your eye. When the conjunctiva becomes irritated or inflamed, the blood vessels become larger and more prominent, making your eye appear red.

Symptoms of conjunctivitis include:

• Inflammation of the eye
• Increased tearing
• Soreness of the eye
• Light sensitivity
• Itchiness of the eye
• Excess mucous (pus)
• Crusting of eyelashes in the morning

[Picture - Inflamed conjunctiva]

What causes conjunctivitis?

Many different sources of eye irritation can cause conjunctivitis. The most common are:

• Infections (viral and bacterial)
• Allergies
• Environmental irritants

Viral infection is the most common cause of conjunctivitis. This same virus produces the familiar red and watery eyes, sore throat, and runny nose of a common cold. Symptoms of conjunctivitis can last from one to two weeks and then will disappear on their own. Discomfort, however, can be alleviated with warm compresses applied to the eyes.

Bacterial infections, such as staphylococcus or streptococcus, cause a type of red eye that produces considerable amounts of pus.

Some bacterial infections, however, are more chronic and may produce little or no discharge except for some mild crusting of the eyelashes in the morning. Antibiotic eye drops are typically used to treat bacterial conjunctivitis.

Infectious conjunctivitis, whether bacterial or viral, can be quite contagious. Practicing good hygiene can help prevent the spread of conjunctivitis if you are infected.

You should:

• Avoid re-using handkerchiefs and towels to wipe your face and eyes
• Wash your hands frequently
• Keep your hands away from your eyes
• Replace your eye cosmetics regularly -do not share with other people
• Properly clean your contact lenses

Allergic conjunctivitis is not infectious or contagious. It occurs when the body is exposed to materials that cause an allergic reaction, such as pollen or dander, and is often season. Symptoms include redness, itching and/or burning eyes, tearing, enlarged vessels in the sclera (white part of the eye), and puffy eyelids. Treatment often includes applying cool compresses to the eyes and taking antihistamines.

Environmental irritants, such as smoke or fumes, may also cause conjunctivitis. The symptoms are usually similar to those of allergic conjunctivitis.

What are other causes of red eyes?

Generally, conjunctivitis is easily treated. However, if symptoms of conjunctivitis persist for an extended period of time after treatment, you should your eyes examined by your ophthalmologist (Eye M.D.), as these symptoms may indicate a more serious eye problem. There are several eye diseases that cause red eyes, some of which can lead to blindness unless diagnosed and treated.

Eyelid margin disease is a common and persistent inflammation of the eyelids.

Symptoms include:

• Eye & eyelid irritation
• Itchiness of the eye
• Redness of the eye

This condition frequently occurs in people have a tendency towards oily skin, dandruff or dry eyes.

With blepharitis, both the upper and lower eyelids become coated with oily particles and bacteria near the base of the eyelashes. It may cause irritation, itchiness, redness, and stinging or burning of the eye.

What causes blepharitis?

Everyone has bacteria on the surface of their skin, but in some people, bacteria thrive in the skin at the base of the eyelashes. Large amounts of bacteria around the eyelashes can cause dandruff-like scales and particles to form along the lashes and eyelid margins.

Blepharitis also is associated with meibomitis - dysfunction and inflammation of the nearby oil glands of the eyelids (called meibomian glands).

How is blepharitis treated?

Blepharitis is often a chronic condition, but it can be controlled with the following treatment:

Warm compresses: Wet a clean washcloth with warn water, wring it out, and place it over your closed eyelids for at least one minute. Repeat two or three times, rewetting the washcloth as it cools. This will loosen scales and debris around your eyelashes. It also helps liquefy oil secretions from nearby oil glands, preventing the development of a chazion (pronounced kuh-LAY-zee-un)-an enlarged lump caused by clogged oil secretions in the eyelid.

Eyelid scrubs: Using a clean washcloth, cotton swab or commercial lint-free pad soaked in warm water, gently scrub the base of your eyelashes for about 15 seconds per eyelid.

Antibiotic ointment: Your ophthalmologist may prescribe an antibiotic ointment. Using a clean fingertip or cotton swab, gently apply a small amount at the base of the eyelashes before bedtime.

Artificial tears or steroid eye drops: These may also be prescribed temporarily to relieve dry eye or inflammation.

Good hygiene: Because blepharitis can be a persistent problem, you should practice good skin and eyelid hygiene to prevent recurrences. In addition to careful cleansing of your eyelashes, washing your hair, scalp and eyebrows with antibacterial shampoo can also help control blepharitis.

The term chalazion (pronounced sha-LAY-zee-un) comes from a Greek word meaning "small lump." A chalazion is an enlargement of oil-producing gland in the eyelid called the meibomian gland. It forms when the gland opening becomes clogged with oil secretions. It is not caused by an infection from bacteria and it is not a cancer.

What is the difference between a chalazion and a stye?

A chalazion is sometimes confused with a stye, which also appears as a lump on the eyelid. A stye is a red, sore lump near the edge of the eyelid caused by an infected eyelid follicle.

Initially a chalazion may resemble a stye, but it usually grows larger, sometimes as large as a pea. Chalazia also tend to develop farther from the edge of the eyelid than styes.

How is a chalazion treated?

About 25 percent of chalazia have no symptoms and will disappear without any treatment. Sometimes, however, a chalazion may become red, swollen and tender. A larger chalazion may also cause blurred vision by distorting the shape of the eye. Occasionally, a chalazion can cause the entire eyelid to swell suddenly.

Symptoms are treated with one of more of the following methods:

Warm compresses: Warm compresses help to clear the clogged gland. Soak a clean washcloth in hot water and apply the cloth to the lid for 10 to 15 minutes, three or four times a day until the chalazion is gone. You should repeatedly soak the cloth in hot water to maintain adequate heat.

Antibiotic ointments: An antibiotic ointment may be prescribed if bacteria infect the chalazion.

Steroid injections: A steroid (cortisone) injection is sometimes used to reduce inflammation of a chalazion.

Surgical removal: If a large chalazion does not respond to other treatments or if it affects your vision, your ophthalmologist (Eye M.D.) may drain it surgically. The procedure is usually performed under local anesthesia in your ophthalmologist's office.

A chalazion usually responds well to treatment, although some people are prone to recurrences. If a chalazion recurs in the same place, your ophthalmologist may suggest a biopsy to rule out more serious problems.

The vitreous is the clear gel occupying the central cavity of the eye, located between the crystalline lens and the retina. It is responsible for nourishing internal structures of the eye and helping the eyeball maintain its overall shape. As we age, the vitreous gel gradually liquefies and shrinks and may eventually separate from the back of the eye. When this occurs, the process is called a posterior vitreous detachment (PVD). This is a very common, usually harmless condition which occurs in most individuals at some point. It is said that the percent chance of having a vitreous detachment is at least the same as one's age. However, a PVD may occur earlier than normal in moderately to extremely nearsighted people, as well as in people who have had cataract surgery.

As the vitreous pulls free from the retina, it is often accompanied by light flashes or floaters. Floaters are caused by tiny bits of vitreous gel or cells that cast shadows on the retina. These appear as dots, spots, or curly lines that appear suspended in front of your and move with your eye. People often think these floaters are flying bugs. Flashes occur when the vitreous tugs on the sensitive retina tissue as the vitreous is pulling free. Flashes may look like camera flashes, lightning bolts or colorful lights.

There are other more serious causes of lashes and floaters, however. Retinal tears, retinal detachment, infection, inflammation, hemorrhage, or an injury such as a blow to the head may also cause floaters and flashes. Occasionally, flashes of light are caused by neurological problems such as migraine headache. When related to a headache, the flashes of light are seen in both eyes and usually last 20-30 minutes before the headache, if any. Symptoms of PVD are often noted in one eye at a time.

Signs and symptoms of PVD:

• Black spots or "spider webs" that seem to float in the vision in a cluster or alone
• Spots that move or remain suspended in one place
• Flickering or flashing lights that are most prominent when looking at a bright background like a clear, blue sky

Symptoms that may indicate a more serious problems

Call us immediately if you notice these changes in symptoms

• Sudden decrease of vision along with flashes and floaters
• Veil or curtain that obstructs part or all of the vision
• Sudden increase in the number of floaters and/or flashes
• Floaters typically become less bothersome over a period of weeks to months as they settle below the line of sight.

Tobacco smoking is directly linked to many adverse health effects, including high blood pressure, heart disease and cancer. Smoking is also linked to specific eye disease.

How does smoking affect the eyes?

People who smoke cigarettes are at increased risk for developing cataracts, a clouding of the naturally clear lens of the eye. Cataracts cause a variety of vision problems, including blurry distance vision, sensitivity to glare, loss of contrast and difficulty seeing colors. When glasses or magnifiers are no longer helpful for someone with cataracts, or when cataracts develop in both eyes, surgery is the only option.

Tobacco smoking is also one of the preventable risk factors for age-related macular degeneration (AMD). Studies have shown that current smokers and ex-smokers are more likely to develop AMD than people who have never smoker. AMD has two forms: dry (called atrophic or non-neovasular) AMD and wet (called exudative or neovascular) AMD. In dry AMD, your retina gradually thins. There is no proven cure for this type of degenerative disease. In wet AMD, new blood vessels grow in the retina, leaking blood or fluid and damaging the macula, the part of the retina responsible for your central vision.

The two types of treatment currently available for specific forms of wet AMD are standard laser surgery and photodynamic therapy, both of which may stabilize the disease.

In people with high blood -sugar levels, some studies suggest that smoking may be linked to diabetic retinopathy, or damage to the blood vessels in the retina.

The optic nerve is also susceptible to damage from smoking. People with poor diets who smoke heavily and drink excessive amounts of alcohol run the risk of developing optic nerve-related vision loss (called tobacco-alcohol amblyopia). Certain optic nerve problems run in families (called Leber's hereditary optic neuropathy). People with this condition who smoke have increased risk of vision loss. In some patients with thyroid disease (called Graves' disease) who also have eye involvement, smoking can cause the eyes to become worse, with vision loss possible.

People who do not produce enough tears to keep this eyes comfortably lubricated have a condition called dry eye. For these people, smoking is a significant irritant, worsening the symptoms of scratchiness, stinging or burning of the eyes, and excess tearing from irritation.

How does smoking affect fetal/infant eye health?

Studies have also a strong association between smoking during pregnancy and the risk of invasive meningitis during early childhood. The risk of bacterial meningitis is five times higher among children whose mothers smoked during pregnancy. In addition to other severe health problems, childhood meningitis can cause inflammation of the cornea and pink eye.

Smoking during pregnancy is also associated with low birth weight and premature birth. And finally, oxygen therapy given to sustain the lives of premature infants can cause retinopathy of prematurity, causing permanent vision loss or blindness.

There are resources to help you quit smoking. There are numerous community organizations committed to helping people quit smoking. The American Cancer Society (ACS) offers smoking cessation classes around the U.S.

Contact ACS at 1 (800) ACS-2345 or online at www.cancer.org to find the chapter near you.

LASIK Laser Vision Correction surgery

Dr. Debra Malley is a specialist in Laser Vision Correction surgery, such as LASIK. She utilizes the latest technology in blade-less custom Wavefront-guided LASIK to treat patients for correction of nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. After an initial comprehensive ophthalmic examination with one of our doctors, patients who are determined to be a likely candidate for Laser Vision Correction (LVC) surgery can then schedule an appointment at the Kremer Laser eye Center in Cherry Hill for final analysis and testing prior to consideration for LVC surgery. This testing is done to ensure that each patient is carefully screened such that only those people who are deemed ideal candidates for LVC surgery are given this option. Some people have eyes that are not suitable for LVC - LASIK surgery in which case we would recommend they remain in their glasses and/or contact lenses. LASIK surgical procedures are performed by Dr. Malley at the Kremer Laser Eye Center in Cherry Hill, NJ. There is no charge for an initial consultation and pre-surgical testing and evaluation. Our ultimate goal is that each and every patient receives the most appropriate eye care that is in their best interest.

Laser Refractive Surgery: It is a surgical procedure that uses the excimer laser to correct nearsightedness, farsightedness, and/or astigmatism.

Wavefront Technology: An advanced method of measuring visual distortions (also known as aberrations) of the eye before refractive surgery to enhance visual outcomes afterwards.

Cosmetics

Juvéderm™ Injectable Gel

Juvéderm is an injectable gel that gently reverses many signs of aging in the face, including fine lines and wrinkles, crow's feet, thinning lips and loosening skin. Results last about 6-9 months and can be made to last even longer with a simple follow-up treatment a few weeks after the initial injection.

BOTOX® Cosmetic

BOTOX® Cosmetic is a purified protein. It is a nonsurgical, physician-administered treatment that can temporarily reduce moderate to severe frown lines between the brows in patients 18 to 65 years of age.